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WAL-MART PHARMACY 10-3847
CH091300 CANYONLANDS COMMUNITY HEALTH CARE
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Covered Entity Details
Entity Name
CANYONLANDS COMMUNITY HEALTH CARE
Subdivision Name
Canyonlands Healthcare - Lake Powell
Type
HRSA-Funded Health Center
340B ID
CH091300
Entity Address
467 VISTA AVENUE
PAGE, AZ 86040
Grant Number
H80CS00448
Participating Start Date
10/1/1998
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3847
Pharmacy Address
1120 WEST PIONEER BLVD
MESQUITE, NV 89027
Pharmacy Comments
Contract Details
Approval Date
11/2/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/2/2017
Agreement registered in error
Contacts
Covered Entity Signing Official
Christopher Hansen, CEO
(928) 645-6600
Contract Pharmacy Representative
Canyonlands Healthcare
Andrew J Lewandowski, Director of Pharmacy
(928) 645-9675 Ext: 2205
Signed By Date
11/2/2017
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